In April 2016, the government announced the creation of the Australian Medical Research Advisory Board to determine the medical research strategy and priorities to guide the funding allocated through the MRFF. Although its mission is clear, the board faces the challenging task of identifying research priorities and allocating the available budget across topics and programs competing for funding.

The criteria for identifying research priorities to guide the government decision making on program level funding, as set out in the MRFF legislation, focus on the ability of research programs to deliver the greatest value for as many Australians as possible. However, there is little mention of how the value of research programs would be objectively, transparently and practically assessed to inform research prioritisation and ensure efficient use of the MRFF budget.

Common approaches to research prioritisation in Australia

Priority areas for medical research in Australia are typically identified through consultations with major stakeholders, such as research funding organisations (eg, the National Health and Medical Research Council [NHMRC] and the Australian Research Council [ARC]), researchers, and through direct consultation with patients and their representatives. Measures of the burden of disease are often considered during this process, based on the notion that focusing research on diseases of high population and cost will deliver high societal value. However, there is often a chasm between national priority areas and the bottom-up approach, whereby individual researchers submit grant applications on the topics of their own interests and compete with other researchers for funding from a limited budget.

Decisions on which specific research programs (eg, clinical trials) to fund are usually made based on the assessments of the merits (eg, scientific rigour, strength of the research team) of the submitted research proposals, according to the opinions and judgments of experts sitting on funding panels. Nevertheless, this approach is based on panel members’ inherently subjective views on the potential value of a piece of research, with little or no reference to explicit estimates of the incremental costs and benefits of proposed research programs. In addition, there is a potential for research duplication due to the lack of coordination across panels in the various funding organisations. Research duplication can also happen when funding is granted to research projects to generate evidence that can be sourced from relevant international research. In this case, resources may be better deployed on other studies or activities, such as dissemination and implementation of findings.

To maximise benefits from research budgets, funding decisions should be based on each research proposal’s ability to provide the best value for money, based on explicit evidence on the proposals’ cost and potential benefits (here, here and here). Even when the research project is on a disease with high burden, it may not be worthwhile if the expected costs of conducting a research study exceed its expected benefits. Similar assessments of benefits and costs have been the standard in guiding funding decisions of other health care investments in Australia (eg, pharmaceuticals and health services). There is, therefore, no reason why research funding should not be subjected to the same scrutiny to achieve efficiency in spending public funds.

Analytical approaches for assessing the value of research

A number of analytic approaches have been proposed to quantify the value of research programs, particularly in research intended to evaluate health care interventions (eg, clinical trials and observational studies). These approaches estimate the expected benefits of research on improving health care, which is expressed as improved health outcomes (eg, survival) or, in terms of monetary benefit, using a willingness to pay value for an additional unit of health outcome (eg, $50 000 per life year gained).

VoI is an alternative quantitative approach to research prioritisation that has received increased attention. This method has firm foundations in statistical decision theory and provides a systematic approach to estimating the expected value of acquiring new evidence to inform a decision problem. The approach considers the uncertainty in the relevant available evidence, the consequences of this uncertainty (ie, the cost of making a wrong decision), the population that would benefit from the results of the intended research and the expected cost of the research (here, here and here).

Thus, VoI considers both the burden of the disease and the uncertainty in existing evidence to advise whether additional research is potentially worthwhile. This is essential to reduce research duplication and wastage by directing research funds to worthy research programs, and to enhance equity by improving the opportunity of research funding for programs studying rare diseases, where there is a small population but a high information need. Moreover, the value of research estimates obtained using VoI can be adjusted to the expected level of implementation to reflect the impact of research findings on real-world practice (here and here).

The MRFF Advisory Board needs to develop innovative and flexible frameworks within which the research priorities can be set. A preferred framework would combine both quantitative and qualitative considerations to ensure that research funding is efficient, sustainable and equitable, and at the same time responsive to the clinical needs for high quality and innovative medical research.

A possible option would be to use consultations with major stakeholders and considerations on the burden of disease to identify the broad areas of research funding priority, and to use VoI analysis to assess the value of research programs within each priority topic. To further reduce the burden of VoI analysis, this approach could be reserved for the most costly research projects. Committee discussions may ensue to refine decisions allowing for additional attributes, such as capacity building or targeting disadvantaged groups.

Dr Haitham Tuffaha is from the Centre for Applied Health Economics at Griffith University.

Dr Lazaros Andronis is a lecturer in Health Economics at the Health Economics Unit of the University of Birmingham in the UK.

Professor Paul Scuffham is director of the Centre for Applied Health Economics at Griffith University, and deputy director of the Menzies Health Institute Queensland.

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